Exploring the availability and accessibility of medication abortion pills in Nepal pharmacies: Reported versus actual provision practices
Bibliographic record
Abstract
OBJECTIVES: The Nepal government allows medication abortion pills to be dispensed from pharmacies if the patient has a prescription. We aimed to assess the availability of medication abortion pills, with and without a prescription, from pharmacies and the provision practices of pharmacy workers in Eastern Nepal. STUDY DESIGN: We conducted a cross-sectional survey among 489 pharmacy workers to document knowledge, availability, and provision practices related to medication abortion pills. After a month, we revisited 180 pharmacies using a mystery client approach to understand actual provision practices. We analyzed these data with descriptive statistics. RESULTS: Pharmacy workers in about 16% (n = 28/180) of surveyed pharmacies reported selling medication abortion pills. In contrast, mystery clients obtained these pills without a prescription in more than one-third (n = 69/180, 38%) of their visits. All mystery clients obtained mifepristone and misoprostol either through combination packages (n = 59/69, 86%) or in separate packages (n = 10/69, 14%). Mystery clients paid an average of 1062 Nepali Rupees (NRS) (approximately USD8), about 1.6 times more than the NRS654 (approximately USD5) price reported during the survey. Pharmacy workers asked mystery clients questions about gestational age to confirm pregnancy status and provided information on the timing of use and possible side effects. CONCLUSIONS: Despite the current regulatory status, our findings suggest mifepristone and misoprostol are available without a prescription in about two out of five community pharmacies in Eastern Nepal. Supporting efforts to ensure women seeking medication abortion pills from pharmacies have up-to-date and medically accurate information appears warranted. IMPLICATIONS: Pharmacies are increasingly becoming key players in the community-based distribution of mifepristone/misoprostol in Nepal. Supporting pharmacy workers to provide medication abortion pills without a prescription at scale could advance equitable access to abortion care. Ensuring appropriate training for pharmacy workers is essential to safeguard service quality and safety.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".